Carpal tunnel syndrome in pregnancy.
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Adolescent↗
Biomedical subjects
G G Nicholas
Publications and source records attributed to G G Nicholas.
Recombinant tissue plasminogen activator for the treatment of lower extremity peripheral vascular occlusive disease.
PURPOSE: Regional thrombolysis in the recanalization of peripheral vascular occlusive disease is an increasingly accepted therapeutic modality. Efficacy and complication rate are major issues in thrombolytic therapy. This prospective study was undertaken to determine if locally delivered recombinant tissue plasminogen activator (r-TPA) is safe and effective in clot lysis at non-weight-adjusted doses. PATIENTS AND METHODS: Twenty patients (undergoing 21 infusions) from two centers underwent fibrinolytic therapy with use of r-TPA, at a dose rate of 2 mg/h. The mean duration of arterial occlusion was 27.2 days (range, 1-117 days). Concomitant intravenous heparin anticoagulation was administered to all patients. A coaxial infusion delivery system was employed. Hematologic parameters and angiographic follow-up were evaluated at 4-hour intervals during thrombolytic infusion. The chosen maximum r-TPA dose of 40 mg could be extended at investigator discretion. RESULTS: Complete clot lysis was achieved in 18 of 21 (85.7%) infusions at a mean total dose of 38.9 mg (range, 8-84 mg). The mean infusion duration was 19.7 hours. In 16 of 19 (84.2%) infusions, in which the nadir fibrinogen level was recorded, it remained greater than 65% of baseline. Three of 21 (14.3%) infusions resulted in three major bleeding complications, one of which resulted in death. CONCLUSION: In this two-center trial, catheter-directed r-TPA infusion at 2 mg/h is effective for clot lysis. When combined with concomitant heparin administration, this treatment may result in an unacceptably high frequency of bleeding complications.
Adult↗
Review of a community hospital experience with carotid endarterectomy.
Carotid endarterectomy was performed 743 times during 56 months in a community hospital by 24 surgeons. The mortality rate was 2.7% and permanent stroke occurred in 1.8%. Temporary postoperative neurologic deficit occurred in 3.5%. The frequency with which the surgeon performed the procedure did not appear significant in the incidence of postoperative morbidity and mortality.
Adult↗
Transvenous "rescue" of a Kimray-Greenfield filter from the right atrium.
The complications of transvenous interruption of the inferior vena cava are most commonly associated with premature discharge of the device or inadvertent placement at a site other than the preselected position which is most commonly the infrarenal vena cava. This case report illustrates a useful technique for the transvenous retrieval of a partially ejected Kimray-Greenfield filter that became lodged in the right atrium. This simple technique may save the need for open thoracotomy to retrieve the misplaced filter.
Aged↗
Aorto-enteric fistula presenting as multicentric osteomyelitis.
A 60-year-old man treated with a prothesis for aorto-enteric fistulae developed multicentric osteomyelitis. Enteric flora were cultured from blood and bone but the diagnosis was delayed. Aorto-enteric fistulae can occur in a variety of circumstances but have become more common with the advent of reconstructive vascular surgery using prostheses. This entity frequently does not present in a dramatic way, but can be the cause of fatal bacteremia and septicemia.
Aorta, Abdominal↗
Vascular laboratory and deep venous thrombosis: impact on management.
Two hundred and twenty-nine patients with the diagnosis of deep venous thrombosis admitted to the hospital prior and subsequent to the development of our vascular laboratory were reviewed. The institution of a clinical vascular laboratory improved the accuracy of diagnosis of deep venous thrombosis. The percentage of patients undergoing venography increased from 34 to 110 (31%) to 70 of 119 (59%), documenting an increased demand by the clinician for objective confirmation of the clinical diagnosis of deep venous thrombosis. Fifty-five patients had both phlebography and vascular laboratory examination. Twenty-seven of these had phlebograms along with pulse volume recordings of maximum venous outflow with Doppler ultrasound. The overall accuracy was 71.4%, with false positives in 22.2% (6 patients) and false negatives in 7.4% (2 patients). Phleborheography and phlebography were done in 28 patients. The overall accuracy of phleborheographic examination was 89.3%. The false positive rate was 3.6% (1 patient) and the false negative rate was 7.1% (2 patients).
Doppler Effect↗
Carotid endarterectomy in symptomatic patients.
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Aspirin↗